The amount of innovative work underway to improve the care we provide our community is truly remarkable. Though we have a multitude of ongoing projects by staff supporting our four priority areas ( Patient Safety; Health Home; Leadership and Oversight; and Best People/Workforce), I would like to highlight the two areas of Health Home and Patient Safety this month.

Increasing Access

Health Home encompasses access and capacity with the focus on increasing primary care capacity and strengthening our primary care model. We have many efforts related to this happening at our Regional Medical Center and Health Centers. Two new facilities are being built to help expand access to primary care, emergency services and mental health services. The Martinez Wellness Center, which is located next to the Emergency Department (ED) and opens early next year, will offer primary care, "Fast Track" ED care, as well as outpatient mental health services, pediatrics, family medicine and group medical visits.  A 16-bed, adult inpatient mental health Crisis Residential Facility also is scheduled to open next door to CCRMC this fall.

In addition, Medical Staff President Dr. Ori Tzvieli and I will be working together with internal and external experts to come up with a comprehensive solution to address access in the ED. Like hospitals around the country, we continue to face high demand for emergency services and recognize the solution needs to address the issue of space and the need for increased access to primary care so ED visits can be avoided when possible.

We also are working with our health care provider partners to offer expanded evening and weekend care at our new West County Health Center thanks to support from John Muir Health. The after-hours, non-emergency medical care will provide a convenient option for people who want to be seen the same day but don't require a trip to an emergency department.  We have partnered with Doctors Medical Center in San Pablo and our Health Plan Advice Nurses to create this new way to provide more appropriate care and reduce the demand for costly repeat visits to an emergency department. We are excited to bring this much needed service to the community.

We have improved how we make appointments for our patients and are seeing very encouraging results. Spearheaded by Ambulatory Care Director Dr. Chris Farnitano, the redesign of our appointment line has resulted in a dramatic reduction in the average amount of time patients are spending on hold to make appointments from 14 minutes to about three minutes. We now frequently have same- or next-day appointments available throughout the day. Before the system redesign, we usually ran out of those appointments by 9 a.m.

Improving Care

Patient safety continues to be a top priority (see story on our Hospital-Acquired Pressure Ulcer Prevention Team). Our staff had the opportunity to present their work on several safety improvement initiatives and received positive feedback when the National Association of Public Hospitals Safety Network (NSN) visited last week. CCRMC joined the NSN Transformation Initiative in 2012. This national initiative supports safety net hospitals in their efforts to improve patient safety, improve health equity and examine how disparities affect patient safety and care, and promote patient and family engagement.

We still face challenges but we continue to meet and overcome these challenges. I thank all of you for your hard work to improve the health of our community as a whole and to provide the best care at the lowest cost in the way those we serve need and want.

More very soon,

Ten years ago, Kristin Moeller graduated from our Family Medicine Residency Program. Now she's running the program.

After graduating from the program in 2003, Dr. Moeller stayed on as a family physician and spent many years teaching new residents. Two years ago, she became more involved in the program serving on the Residency Leadership Group. She also helped craft the program's new mission statement. Dr. Moeller said her one of her goals as director will be to develop a long-term plan for the program, which she refers to as the "2020 Vision."

Our program, which trains residents to become multitalented family physicians, has been recognized nationally for years. It attracts more than 700 applicants every year, yet only 14 are accepted. Many of our residents - who come from across the country -- stay in Contra Costa to practice medicine here.

Dr. Moeller takes over for former director Dr. Jeremy Fish. 

Dr. Jeremy Fish

Phase 2 of that organizational effort involves the formation of five Regional Residency Collaboratives--Great Valley, LA-South, LA-North, Orange-South, and the Bay Area. On April 18,  Dr. Fish brought together program directors and assistant program directors from UCSF, Stanford, Santa Clara, Santa Rosa, Kaiser-Santa Rosa, Kaiser-Napa-Solano, Salinas and Contra Costa Family Medicine Residencies for the first Bay Area Family Medicine Education Summit. The group set the following Bay Area Regional priorities:

• Relationship and Network development across all programs in the region
• Collaborative Faculty and Leadership Development
• Collaborative Recruitment & Renewal
• Resource Development for Family Medicine Residency Education

The group decided to meet on a quarterly basis and will develop a regional Advanced Life Support Obstetrics course by early next year with one session at UCSF in the fall and one in the winter in Salinas.

 A multidisciplinary team has made great strides in preventing hospital acquired pressure ulcers (HAPUs) at our Regional Medical Center. While work has been ongoing in this area for some time, the HAPU team was restructured in 2011 with the team meeting more often, the frequency of monitoring increased from quarterly to monthly , and additional training was provided to staff regarding wound assessment and the 4 Eye Skin Assessment. The 4 Eye Skin Assessment on admission and transfer concept was adapted and expanded from the Institute for Healthcare Improvement Mentor Hospital Registry information. Owensboro Medical Health System in Owensboro, Kentucky  originally developed the 4 Eye Skin Assessment on admission. 

The HAPU Prevention Team.

The HAPU Prevention Team  is helping CCRMC to reach one of the required performance measures outlined in CCRMC's DSRIP plan to decrease the percentage rate of patients with hospital acquired pressure ulcers with category II or higher.  As a result, from January 2012 to April 2013 we have experienced a 67% reduction in our HAPU rate of patients with Category II or higher HAPUs.

Inpatient Nursing Director Jeanette Black credits the team's success to a supportive environment that involves frontline staff in the work. "Because our leadership supports improvement work, we have been able to make real progress. Frontline staff was involved directly in the development of the improvements and made possible the implementation of changes that resulted in better care for our patients," she said. 

The HAPU Prevention Team members include: Jeanette Black, Nurse Program Managers Helena Martey and Holly Longmuir, Physician Champion Dr. Kim Haglund, Charge Nurses Ira Beda-Sabio,  Senait B. Tesfe,  Grace Ma, Laurinda Abena and Registered Nurses  Jennifer Sanchez,  Wayne Dixon,  Josephine Belleza,  Jenny Blackman, Josie Gonsalves , Rosalie Cabading , Eskinder Daba,  Carla Dockham, Lori Yaniz , Rosemary Leta ,  Ngozi Umozurike, Quality Manager Donna Garro,  Acting Patient Safety Officer Brenda Stewart ,  Nurse Educator Barbara Simmons and Betty Carpiso, EPIC Application Analyst.

The Pediatric Response Team - a specialized team of doctors, nurses and health professionals at the hospital - conducted a series of drills this month to prepare for health emergencies involving children. The drills practice when and how to call the Pediatric Response Team, and what role each member plays in the care of an ill child in the Emergency Department. In delivering critical care, communication is very important, and time is given to critical language practice during medication orders, for example. 

The purpose of the Pediatric Response Team is to provide very ill children rapid emergency treatment. The team is activated when a child under 14 years of age has abnormal level of consciousness, poor color, breathing difficulty, concerning or worsening vital signs such as low oxygen or blood pressure, or when any staff member is concerned about a serious illness and wants the Pediatric Response Team to rapidly assess and manage for optimum care. 

The scenario for the May drill involved a child with sepsis, an overwhelming infection that requires IV fluids, antibiotics and coordinated transfer to a pediatric intensive care unit.  More drills are planned for November to practice these infrequent, but high-risk scenarios. 

For more information about the Pediatric Response Team, contact Dr. Amy Buoncristiani at Amy.Buoncristiani@hsd.cccounty.us

Team Last month's Rapid Improvement Event (RIE) focused on improving our medication refill process, starting at our medication refill rewrite desk. Currently, 75% of our medication refill requests are sent by fax to our rewrite desk in Martinez. At this desk are six pharmacy techs that take close to 700 faxes each day and enter them into ccLink. Due to the volume of work, it can take three days to process the request. All refill requests are routed to the prescribing provider, which can cause delays if that prescriber is not the primary care provider (PCP). 

Meanwhile, medication Clarifications and Prior Authorizations that arrive at the rewrite desk were faxed again to each of our clinic sites. This translates to an average of 50 faxes per day that our health home teams had to sort through.

Three months of refills processed by the rewrite staff.

The RIE team tested ways to improve communication, eliminate variation and streamline the process. For instance, Prior Authorization and Med Clarification faxes were entered into ccLink instead of being refaxed to the clinics. The team also used a list of the top 25 most commonly prescribed meds to route refills to the PCP if they were not the prescriber. From a sample of 24 requests, 12 were rerouted to the PCP.  All 12 requests were approved and done within 24 hours.

You can read more about the improvement team's efforts here. You can also view the team's full Report Out on iSITE. The third Primary Care Rapid Improvement Workshop on External Referrals will be May 20-24 with Report Outs on Friday, May 24. 

Contra Costa Health Plan and Regional Medical Center leadership negotiated new guidelines this month for documenting the prescription of opioids with Walgreens pharmacy after a pharmacy policy change created delays for some of our patients getting medication.  

Walgreens began requiring more documentation to fill opioid prescriptions to fulfill terms of a lawsuit settlement with the U.S. Drug Enforcement Agency. To address the delays, we worked on an agreement with Walgreens to develop a plan that we hope will better meet the needs of our patients. 

Pharmacists will now only fill opioid prescriptions that include a specific diagnosis (ICD9 Code not required). If the CURES database shows the patient's cumulative prescriptions exceed 120mg daily of morphine sulfate or its equivalent, the pharmacy will require more information from Health Services about the patient's treatment. But the pharmacist will still fill the prescription while waiting for that information, unless it is not received by the time the next refill is due or unless there are other significant issues. 

Directors of all Medi-Cal managed care health plans in California met late in April to discuss the need to control the epidemic of opioid misuse, and agreed that the 120mg-per-day threshold should serve as a flag to require additional medical information. We will review our plan with Walgreens in one month, and we are pursuing a similar agreement with Rite Aid. 

Patients in the Cancer Center are now being given the option of checking out iPads to help them pass the time as well as learn about their conditions and medical treatments while receiving chemotherapy. During their treatments, which can last several hours, patients can now surf the Internet, read the news, listen to music, watch TV programs, play games like Angry Birds in addition to reading information about chemotherapy and health issues.

The eight iPads being used in the Cancer Center were purchased by the CCRMC Auxiliary, which is a component of the CCRMC volunteer program that plans and conducts fundraising and special events that benefit CCRMC patients, staff and the community. When patients arrive for treatment at the Cancer Center, a volunteer offers them the choice of checking out an iPad. The volunteers also demonstrate how to use the iPads for those unfamiliar with the tablets. 

Devoted volunteers who retire from the hospital's volunteer program can now qualify for emeritus status and be eligible to receive various membership perks.

The CCRMC Auxiliary recently created the emeritus designation as a way of honoring those who have served with distinction as volunteers for 10 years or more.

Emeritus volunteers will receive or retain a parking pass, get a 25% discount at the Gift Shop, have Auxiliary dues waived, and be recognized on a special plaque located in the hospital. In April, the first five volunteers bestowed with the emeritus status - who have logged a combined 43,778 hours of service time - were honored during a volunteer appreciation luncheon.

One of those emeritus volunteers, Doris Greene, put in more than 16,000 hours of service over a 25-year period, many of them as co-manager of the Gift Shop. "I have often told people that I get much more out of volunteering than I give, as I think the very act of volunteering can make you feel good about yourself," Doris said. "You are giving of yourself for the benefit of others. "

Volunteers play an integral role at CCRMC and perform a variety of duties such as providing assistance to patients and medical staff, clerical tasks and, of course, working in the Gift Shop. Some even play music and entertain our patients and staff.

Click here to find out more about how to qualify to become a CCRMC Volunteer Emeritus. You can also contact Volunteer Program Coordinator Rhonda Smith at rhonda.smith@hsd.cccounty.us or (925) 370-5440

Do you know someone who has gone to extraordinary lengths to help patients? If so, nominate them for the Ruth Pease Award!! This award is given by the Medical Staff to a non-physician who exemplifies the dedication of Ruth Pease. It will be presented at the annual Medical Staff Dinner & Dance in September (date to be determined).  

    
Criteria for nominees:

• Must be a current county health professional
• Embraces professional standards of practice
• Actively engages in delivery of high quality patient-centered care
• Delivers service to the patient, institution, and the profession
• Acts as a steward for the institution and breaks the typical barriers/silos of care delivery
• Has a passion for change

History of Ruth Pease: A long-time employee of health services division, Ruth served in various roles and work settings as a Registered Nurse. She worked enthusiastically and tirelessly to positively affect bedside care delivery. She never lost the focus that our patients are the center of it all. 

Please submit your nominations via email to spfister@hsd.cccounty.us no later than Monday, July 1, 2013. 

Patients receiving inpatient mental health  services at our Regional Medical Center partook of punch, cake, music and dancing during the inaugural "Spring Fling" party last month. The event, hosted by the Behavioral Healthcare Partnership, is part of a series throughout the year intended to brighten the experience of our clients. Staff, patients and family members joined in the fun, which included a "Garden of Hope" station where patients made paper flowers, courtesy of the Healing Through The Arts program. 

The Partnership, a collaboration formed in 2009 between medical professionals, community groups, patients and their families, strives to improve the quality of care for the county's mental health care clients. It is part of a broader effort at CCRMC to involve patients and family members in hospital operations in order to improve patient care and satisfaction. 

The Behavioral Healthcare Partnership intends to make the party a tradition, with plans to hold four seasonal events each year to help spread some joy to those in need, said Teresa Pasquini, chair of the group.